Chemotherapy: What You Need to Know

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Overview

What is chemotherapy?

Chemotherapy is the treatment of cancer with "anti-cancer" drugs to destroy cancer cells throughout the body. Cancer cells are abnormal (not normal) cells that keep dividing and making more abnormal cells without the regular control seen in normal cell division. Chemotherapy drugs slow or stop cancer cells from growing and making more abnormal cells. Cancer cells go through many steps to grow. There are many types of chemotherapy drugs and each interferes with cell growth at a different step. These drugs can also affect healthy cells, but healthy cells can repair and return to normal.

Chemotherapy may be used to:

cure the cancer

prevent the cancer from spreading

destroy cells that have spread beyond the tumor

decrease the size of the tumor

relieve symptoms, such as pain from the cancer

Chemotherapy is combined with surgery or radiation therapy when it has been shown to be a more powerful approach to treating cancer. Neo-adjuvant therapy is chemotherapy that is given to shrink a tumor before surgery or radiation therapy. Adjuvant chemotherapy is done after surgery or radiation therapy to destroy cells that may be circulating in the body.

How is chemotherapy given?

Chemotherapy drugs travel throughout the body in the blood stream.
The drugs can be given:

through an injection into a vein (intravenous, IV)

by mouth (pill, liquid)

by a shot into the muscle (intramuscular, IM)

or applied to the skin (topically)

The most common way to get chemotherapy is through an injection into a vein. When chemotherapy is given this way, a thin needle is placed in the vein on the hand or the lower arm. The needle will be removed after the treatment is over.

Patients who have veins that are hard to find or need many IV treatments may get a central line. A soft, thin, flexible tube (catheter) is placed in a large vein and stays there for several weeks. It is through the catheter that treatments are given and blood samples are taken. While you will be aware of the catheter, it causes no pain and eliminates multiple needle pricks. Other types of devices that may be used include hickman catheters, port-a-caths, and PICC.

Chemotherapy drugs can be given to specific body areas by using special techniques. Examples are:

intrathecal: chemotherapy is placed directly into the central nervous system

intra-arterial: arteries are used to deliver the chemotherapy directly to organs

intraperitoneal: chemotherapy is delivered directly to the abdomen

intravesical: chemotherapy is placed in the bladder

Overview of the Treatment Process

Initial Consultation

Whenever chemotherapy is being considered as part of your treatment plan, a consultation visit will be arranged for you with an oncologist. An oncologist is physician specially trained in using chemotherapy for treating your type of cancer. The purpose of this visit is to confirm the use of chemotherapy in your treatment, to determine the kind of chemotherapy plan to be used for your treatment, and to answer any questions you may have. The consultation will take from one to several hours, depending on your particular situation. Please bring with you all X-rays, laboratory studies, pathology slides and other tests that have been performed so that they can be reviewed by the oncologist.

During the visit, a detailed history and physical examination will be performed by your physician. Your physician will also discuss their findings with other members of the multidisciplinary treatment team so that all treatments, such as surgery and radiation therapy, will be coordinated to ensure that you can receive the best possible care. At the end of the visit, your physician will review and recommend the role of chemotherapy in your care. If chemotherapy is not recommended, the physician will also discuss the reasons for this.

Informed Consent Process

If chemotherapy is recommended as a part of your treatment, your physician will review in detail the proposed treatment, the reasons for recommending the treatment, and the potential risks and side effects of such treatment. Ample time will be provided so that you have a full understanding of the treatment and related issues and have all of your questions and concerns answered in full. We encourage you to bring family members or significant others with you, as they may be able to help you during the process and have their own questions answered.

Once you feel that you have a full understanding of the proposed treatment, risks, side effects and other possible treatment options, you will be asked to sign a consent form. Before you sign the consent form, you need to make sure that you are comfortable with the explanation that you have received. Even after you have signed the consent, your physician is always available to answer new questions or to provide additional information. You can withdrawal your consent at any time for any reason.

Treatment Planning

How long will my treatments be given?

Chemotherapy is given in cycles. Each cycle consists of the days of your treatment followed by a period of time during which your normal cells can rest. Then, the cycle is repeated.
Your doctor will pick the best schedule for you based on a number of factors, such as:

the type of cancer and its stage

the type of drugs used

other treatments received

response to treatment

It is very important for you to stick to your treatment schedule. This is needed for the drugs to work. Treatment schedules can be adjusted for holidays and special events; just let your doctor or nurse know if you need to reschedule an appointment.

Where are my treatments given?

Most people receive chemotherapy in an outpatient chemotherapy suite. These chemotherapy suites provide comfortable settings where patients receive their treatment and are carefully watched by their chemotherapy nurse, who is specially trained and educated in giving chemotherapy. Sometimes, patients receive chemotherapy in the hospital. This is done when either the medicine's effects need to be watched more closely or the medicine needs to be given over many hours. Other patients receive their chemotherapy at home.

Will it hurt to get the chemotherapy?

Most chemotherapy drugs do not cause discomfort during the treatment. If you receive chemotherapy through a needle in your vein and you feel burning, coolness, pain or another unusual sensation where the needle is inserted into the skin, let your nurse know. Tell your doctor or nurse about any swelling, redness of the skin, or discomfort after treatment.

On-Treatment Examinations

You will see your medical oncologist throughout your chemotherapy treatment. At certain intervals, an appointment with your oncology doctor or nurse will be scheduled for a time just before one of your chemotherapy visits. For example, a patient receiving chemotherapy 3 to 5 times a week may see their oncologist once a week. Your medical oncologist will discuss with you how often your on-treatment doctor appointments will occur.

End-Of-Treatment Visit

Once your chemotherapy has been completed, you will have a final visit with your physician. This will occur just after your last treatment has been administered. During this visit, your doctor will perform an examination and discuss follow-up care.

Follow-Up Care

In general, follow-up appointments occur between 2 and 6 weeks after the completion of chemotherapy. After that, we will follow your progress and see you on a regular basis. We understand that you may be seeing many other physicians, but it is important for us to participate in this follow-up process so that any chemo-related problems can be identified early and treated. We will also stay in touch with your other cancer specialists.

Dec 30, 2014 - Among early-stage breast cancer patients who undergo chemotherapy and/or radiation treatment, the risk for developing treatment-related leukemia, though low, is still double what experts had previously thought, a new analysis reveals. Reporting online Dec. 22 in the Journal of Clinical Oncology, the researchers said the findings should give pause to doctors and breast cancer patients who are considering post-surgical treatment options.